Stop! Collaborate and Listen

In March, you became president of the International Society of Ocular Oncologists. What are your plans?

Firstly, to make it more useful to its members. Two years ago, we asked our members what they wanted. They responded with: a journal, a more international membership, and assistance with guidelines. Past president Arun Singh set up the journal, Ocular Oncology and Pathology, and I’m enthusiastic to be working on the next two. I want people to collaborate on making guidelines, and I really want more people from outside the United States and Europe to be involved – in particular, I would like to engage more people from Asia. Patients there differ from these in the West.

What did you learn as the first non-American president of ARVO?

When you’re at the top of an organization, you can achieve a great deal! Two years ago, Justine Smith gave a summary of the changes in ARVO over the last 10 years. She noted that around 2007, more women got involved in ARVO. Why? Because as President-Elect, I looked at the distribution of the members and then invited women to join our committees – and I did the same for international members. I learned that if you look for great people from around the world, you will find them and make them enthusiastic to participate. Another example is how ARVO’s approach to education was changed. Some of us decided that we should not only organize scientific meetings but also help young researchers learn how to initiate research, and write abstracts and manuscripts. At the time, we had people saying, “You don’t have to teach people that – we are here for science, not for education!” But one of the board members, Jeff Boatright, really embraced this and ARVO has just launched a great website dedicated to education. Getting there involved changing the organization, and it took many people and about ten years. Enthusiasm gets things done.

With current politics, how do you see the international collaborations of the future?

It’s essential that they continue. No person on their own can make great changes. One example is the HORIZON grants. I believe that there are three for the eye (each is worth about €6 million). The trick is to put together the best researchers you can find – but also those with another interest. The uveal melanoma grant focusses on developing a treatment for metastases. If a patient develops them, it will be deadly. We wanted to address that, so we built a multidisciplinary team with researchers and clinicians from the UK, France, Italy, Poland and The Netherlands, as well as the fantastic Champalimaud Foundation in Lisbon. We have some of the best pathologists in the world, the best ocular oncology centers, and some incredibly talented people creating genetically-modified mice and zebrafish models of the disease and its metastases. We learn a lot from each other, and clearly would not be able to do all of this without scientific collaboration across international borders. And again, enthusiasm.

What would an enlightened approach to patient care look like?

All of the specialties working together. In Leiden, we have meetings where the oncologist, the surgeons, dermatologists, and the eye doctors sit together and discuss difficult melanoma cases – both eye and cutaneous. It leads to better care for patients.

Another important area is collaboration with hematologists. Sixty percent of patients that have undergone a stem cell transplantation have dry eyes, but they do not talk about it to their internal medicine doctor because they have so many other problems. In the current system where increasing amounts of time are being spent on electronic paperwork, this is really terrible. Patients need attention. They need to be able to talk and we need to listen to them. The holistic approach is really important. Just look at macular degeneration and smoking; it’s not just about the eye – it’s all the other things as well. But that takes more time – time that isn’t included in the modern financial model of patient care.

How do you help students broaden their horizons?

I really enjoy it when a young student comes into my office and wants to learn more than what’s in the textbooks. I want to help them discover that they can do more than they ever felt possible. If they want to travel, I spend time trying to find out what they want from the trip. A holiday? To learn about clinical ophthalmology in another setting? Or to perform some research that might one day earn them a PhD? When it makes sense, I help them achieve their goal. Usually, when they leave they’re still kids. But when they come back after a year, they’re independent adults – it’s character building.

You’re a visiting professor at a Chinese university? What’s the story there?

I was President of ARVO and was attending a conference in Hong Kong when I met the then President of the Chinese Ophthalmological Society (COS), Xiaoxin Li. We had a lot in common: I was the first international president of ARVO, she was the first woman to be President of COS. We started to talk, and we noticed that we shared very many interests. She then invited me to come to China, and we discussed the option of having a Chinese chapter of ARVO to stimulate discussion. At that time in China, very few people were doing PhDs – everyone was working in the clinic, not much research was going on, and very few people would leave China to do research. So I resolved to go to China every two years and teach the residents how to present data, how to ask a research question and how to write a paper. I’ve now stopped – last time I went, they were already so excellent that there wasn’t much I could teach them!

I’ve been on the editorial board of the journal, Investigative Ophthalmology for a long time now. I saw some information from 2005 that showed that there were only 5 or 6 papers from China in the journal. Of the papers submitted from developing countries, 90 percent were rejected! One of the main problems was if I asked the authors “Why did you do this?”… I would get the answer: “Well, my boss told me I have to do it.” Most of the abstracts just described what they did, rather than asking a question. They were very task orientated, rather than hypothesis orientated. China has in that respect been absolutely brilliant. They spent government money to send the brightest and best abroad, then after 3 or 4 years, they come back to China and get research facilities to work in.

Now they have the problem that clinical work is valued much higher than research. But that’s the same wherever you go in world! I have a Chinese student that has been in my lab for three and a half years. He gave an oral presentation at ARVO last year – these days, he speaks excellent English (my lab speaks entirely in English – not Dutch). He can now write his own papers, he’s just had one accepted in a journal with an impact factor of five. He’s now ready to go back to China and do independent research. And it’s the same story for researchers all over China, that’s everywhere.